Carotid ultrasound versus heart echo to guide fluids in septic shock

Echocardiographic Left Ventricular End Diastolic Area Versus Carotid Artery Duplex as a Sensitive Indicator for Guiding Fluid Resuscitation in Septic Shock Patients . A Prospective Cohort Study

This study will test whether carotid artery Doppler flow or left ventricular end-diastolic measurements from echocardiography better predict which adults with septic shock will respond to a fluid bolus.

Quick facts

• Study type: Observational
• Enrollment: 40 (estimated)
• Ages: 18 Years to 50 Years
• Sex: All
• Sponsor: Ain Shams University (Academic / other)
• Locations: 1 site (Cairo)
• Trial ID: NCT07550400 on ClinicalTrials.gov

What this trial studies

This is an observational study enrolling adults with septic shock to compare carotid artery Doppler measurements (VTI and peak velocity) with echocardiographic left ventricular end-diastolic area/volume as predictors of fluid responsiveness. Investigators will obtain baseline carotid and cardiac ultrasound measures, administer a standardized fluid challenge, and repeat measurements to identify changes associated with increased cardiac output (with a ≥15% VTI change indicating responsiveness). The carotid Doppler protocol is presented as a simple, rapid bedside technique that may be easier to learn and perform in critically ill patients than full echocardiography. The work will be conducted at the Faculty of Medicine, Ain Shams University in Cairo and excludes patients with significant carotid stenosis, prior carotid surgery, or severe valvular disease.

Who should consider this trial

Good fit: Adults aged 18–50 with septic shock and signs of acute circulatory failure who can safely undergo carotid and cardiac ultrasound are the ideal candidates.

Not a fit: Patients with known carotid stenosis >50%, prior carotid surgery, severe valvular heart disease, or local contraindications to carotid Doppler are unlikely to benefit from the carotid-based approach.

Why it matters

Potential benefit: If successful, this could give clinicians a quicker bedside ultrasound method to decide who needs fluids and reduce unnecessary fluid administration.

How similar studies have performed: Prior small studies have shown carotid Doppler VTI can track changes in cardiac output, but direct head-to-head comparisons with LV end-diastolic measures are limited.

Eligibility criteria

Inclusion Criteria:

* ▪ Age:18-50 years old

  * Sex: both males \&females.
  * Patients diagnosed with septic shock according to SOFA score more than or equal 1
  * Presence of at least one sign of acute circulatory failure from:

    1. Low blood pressure (mean arterial pressure \<65 mmHg and / or systolic \<90 mmHg).
    2. Tachycardia\> 120 bpm without other obvious cause of circulatory failure.
    3. Oliguria \<1 ml / kg during the last hour suggestive of circulatory failure.
    4. Blood hyperlactatemia \> 2mmol / l without other obvious cause a systemic circulatory failure.
    5. Another sign justifying, for example vascular increase capillary refill time more than 2 seconds.

Exclusion Criteria:

* ▪ Known significant valvular heart disease (sever aortic insufficiency or stenosis)

  * Known carotid artery stenosis \>50% or previous carotid surgery
  * Clear contraindication to the carotid artery Doppler such as wound or infection or complete or partial occlusion of the carotid artery.
  * Arrhythmias affect stroke volume assessment (atrial fibrillation, frequent PVCs)
  * Dilated cardiomyopathy.
  * Poor transthoracic echocardiographic window
  * Patient refusal

Where this trial is running

Cairo

• Faculty of medicine, Ain Shams University — Cairo, Egypt (Recruiting)

Study contacts

• Study coordinator: baheya kamel

Conditions Septic Shock; Fluid Resuscitation; End diastolic diameter; carotid artery duplex; septic shock